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> I couldn't agree more Nick (and Chris Kirke), this is a public health > issue > and we should steer clear of it. Yes, we do provide active tetanus > immunisation (albeit only after initial childhood immunisation) but > this is > largely for historical reasons and is clearly opportunistic. Besides > active > "booster" immunisation probably does confer some benefit against the > material accident, unlike initial immunisation. To introduce diphtheria > vaccination however would require specific patient counselling and > consent > for a non-emergency situation - that's clearly not our job! It has been around for some time; I have not given tetanus boosters to the over 5 and under 15 population for about 4 years now, as they receive Diftavax, the combined vaccine, at 15 anyway. In general terms it is nothing to do with us, and tetanus immunisation used to be given with every scratch. With an ageing population we would do more good opportunistically checking blood pressure. Best wishes, Rowley Cottingham [log in to unmask] http://www.emergencyunit.com